Narrative and emotion process in psychotherapy: An empirical test of the Narrative-Emotion Process Coding System (NEPCS)

Abstract

Objective: While the individual contributions of narrative and emotion processes to psychotherapy outcome have been the focus of recent interest in psychotherapy research literature, the empirical analysis of narrative and emotion integration has rarely been addressed. The Narrative-Emotion Processes Coding System (NEPCS) was developed to provide researchers with a systematic method for identifying specific narrative and emotion process markers, for application to therapy session videos. Method: The present study examined the relationship between NEPCS-derived problem markers (same old storytelling, empty storytelling, unstoried emotion, abstract storytelling) and change markers (competing plotlines storytelling, inchoate storytelling, unexpected outcome storytelling, and discovery storytelling), and treatment outcome (recovered versus unchanged at therapy termination) and stage of therapy (early, middle, late) in brief emotion-focused (EFT), client-centred (CCT), and cognitive (CT) therapies for depression. Results: Hierarchical linear modelling analyses demonstrated a significant Outcome effect for inchoate storytelling (p = .037) and discovery storytelling (p = .002), a Stage × Outcome effect for abstract storytelling (p = .05), and a Stage × Outcome × Treatment effect for competing plotlines storytelling (p = .001). There was also a significant Stage × Outcome effect for NEPCS problem markers (p = .007) and change markers (p = .03). Conclusion: The results provide preliminary support for the importance of assessing the contribution of narrative-emotion processes to efficacious treatment outcomes in EFT, CCT, and CT treatments of depression.

Obiettivo: Mentre ultimamente i contributi specifici dei processi narrativi ed emotivi all'esito della psicoterapia sono stati al centro dell'interesse nella letteratura della ricerca in psicoterapia, l'analisi empirica dell'integrazione tra narrazione ed emozione è stata raramente affrontata. Il Narrative-Emotion Processes Coding System - NEPCS è stato sviluppato per fornire ai ricercatori un metodo sistematico per identificare gli indicatori specifici del processo narrativo-emotivo, da applicare ai video delle sedute di terapia.

Metodo: Questo studio ha esaminato la relazione tra i marcatori di problemi evidenziati dal NEPCS ​​ (stessa narrazione antica, narrazione vuota, emozione senza storie, narrazione astratta), i marcatori di cambiamento (narrazione di trame concorrenti, narrazione rudimentale, narrazione con esito inaspettato, e narrazione con scoperta), esito del trattamento (guarito rispetto a invariato al termine della terapia) e la fase della terapia (inizio, metà, fine) nelle terapie per la depressione quali la terapia breve focalizzata sull'emozione (EFT), la terapia centrata sul cliente (CCT) e la terapia cognitiva (CT).

Risultati: Le analisi secondo un modello lineare gerarchico dimostrano un significativo effetto sull’esito per la narrazione rudimentale (p = 0,037) e per la narrazione con scoperta (p = .002), un effetto Fase × Risultato per la narrazione astratta (p = .05), e un effetto Fase × Risultato × Trattamento per la narrazione con trame concorrenti (p = .001). E' risultato significativo anche l'effetto Fase × Risultato per i marcatori dei problemi NEPCS (p = 0,007) e per i marcatori di cambiamento (p = 0,03).

Conclusioni: I risultati supportano, in maniera preliminare, l'importanza della valutazione del contributo dei processi narrativo-emotivi all'efficacia dei trattamenti EFT, CCT e CT per la depressione.

Objectivo: enquanto que as contribuições individuais dos processos narrativos e emocionais para o resultado psicoterapêutico têm sido foco de interesse recente por parte da literatura de investigação em psicoterapia, a análise empírica da integração narrativa e emocional raramente tem sido abordada. O Sistema de Codificação de Processos Narrativo-Emocionais (SCPNE) foi desenvolvido de forma a proporcionar aos investigadores um método sistemático para a identificação de marcadores narrativos e emocionais específicos, para aplicação a sessões terapêuticas video-gravadas. Método: o presente estudo examinou a relação entre marcadores de problema derivados do SCPNE (same old storytelling, empty storytelling, unstoried emotion, abstract storytelling) e marcadores de mudança (competing plotlines storytelling, inchoate storytelling, unexpected outcome storytelling, and discovery storytelling) e resultado do tratamento (recuperado vs sem mudança no final da terapia) e a fase da terapia (início, meio e fim) em terapias breves: terapia focada nas emoções (TFE), terapia centrada no cliente (TCC) e terapia cognitiva (TC) para a depressão. Resultados: Análises de modelos lineares hierárquicos (hierarchical linear modelling analyses) demonstraram um efeito significativo do resultado para o inchoate storytelling (p = .037) e para o discovery storytelling (p = .002), um efeito Fase × Resultado para o abstract storytelling (p = .05), e um efeito Fase × Resultado × Tratamento para o competing plotlines storytelling (p = .001). Também se verificou um efeito significativo Fase × Resultado para os marcadores de problema do SCPNE (p = .007) e para os marcadores de mudança (p = .03). Conclusão: Os resultados fornecem suporte preliminar para a importância da avaliação da contribuição dos processos narrativos e emocionais para resultados de tratamento eficazes em TCE, TCC e TC para a depressão.

Ziel: Obwohl der individuelle Beitrag narrativer und emotionaler Prozesse zum Therapieergebnis im Mittelpunkt des aktuellen Interesses in der psychotherapeutischen Forschungsliteratur ist, wurde sich kaum mit der empirischen Untersuchung der Integration narrativer und emotionaler Prozesse befasst. Das Narrative-Emotion Processes Coding System (NEPCS) wurde entwickelt, um Forschern eine systematische Methode für das Erkennen von spezifischen narrativen und emotionalen Prozessmarkern in Videoaufnahmen von Therapiesitzungen bereitzustellen. Methode: Die vorliegende Studie untersuchte die Beziehung zwischen aus dem NEPCS abgeleiteten Problemmarkern (wiederkehrende Geschichten, inhaltsleeres Geschichtenerzählen, Emotionen ohne Geschichte, abstrakte Geschichtenerzählung) und Änderungsmarkern (konkurrierende Handlungsstränge, unvollständige Geschichten, unerwarteter Ausgang und Enthüllungsgeschichten) und Behandlungsergebnissen (remittiert versus unverändert bei Therapieabschluss) und Phasen der Therapie (früh, mittig, spät) in der kurzen emotionsfokussierten (EFT), patientenzentrierten (CCT) und kognitiven (CT) Therapien für Depression. Ergebnisse: Die hierarchisch lineare Modellierungs- Analysen zeigten einen signifikanten Ergebniseffekt für das unvollständige Geschichtenerzählen (p=.037) und das Enthüllungs- Geschichtenerzählen (p=.002), einen Phasen x Ergebnis- Effekt für abstraktes Geschichtenerzählen (p=.05), und einen Phasen x Ergebnis x Behandlung- Effekt für NEPCS Problemmarker (p=.007) und Änderungsmarker (p=.03). Schlussfolgerung: Die Ergebnisse liefern vorläufige Unterstützung für die Bedeutung der Messung des Beitrag der narrativen-emotionalen Prozesse für erfolgreiche Behandlungsergebnisse in EFT, CCT und CT bei der Behandlungen von Depression.

目標：雖然敘說及情緒歷程對心理治療結果的個別影響，長久以來一直是心理治療研究文獻的焦點，但很少見到統整敘說及情緒的實證分析。敘說－情緒歷程編碼系統 (NEPCS)是一種能讓研究者能在治療晤談影片中辨識特定敘說及情緒歷程標記的系統化方法。研究方法：本研究檢視憂鬱症的短期情緒焦點治療 (EFT),個案中心治療 (CCT),及認知治療 (CT)中， NEPCS的問題標記（老故事重複敘說，空洞的故事敘說，所敘說的故事缺乏適當情緒表露，抽象的故事敘說）及改變標記（充滿矛盾對立的故事敘說，逐步想要釐清內在經驗的故事敘說，獨特結果的故事敘說，及有所發現的故事敘說），治療結果（治療終結時復原 VS没有改變）及治療階段（早，中，後）之間的關連。研究結果：階層線性模式分析顯示逐步想要釐清內在經驗的故事敘說 (p = .037)、有所發現的故事敘說 (p = .002)有顯著的治療成效、抽象的故事敘說 (p = .05)有階段 X治療成效、充滿矛盾對立的故事敘說 (p = .001)有階段 X結果 X治療成效。 NEPCS的問題標記 (p = .007)與改變標記 (p= .03)也有顯著的階段 X治療成效。結論：研究結果初步支持了評估敘說－情緒歷程對憂鬱症的 EFT、CCT及 CT治療效能影響的重要性。

Keywords:

• narrative
• emotion
• process
• outcome
• depression
• psychotherapy integration

Notes

¹ In any discussion of narrative and psychotherapy it is important to distinguish between the following constructs. At the level of psychotherapy practice, a narrative-informed approach to therapy refers to instances where narrative concepts have been assimilated into established psychological theories in an effort to further examine and understand existing ideas about the therapeutic process. Conversely, narrative therapy is a psychotherapeutic approach that focuses on the externalization of problem-saturated stories as a means to help individuals “restory” their difficulties by understanding them in relation to socially and culturally mediated interactions. At the level of psychotherapy research, narrative analyses of therapy are distinguished from the study of narrative in therapy (McLeod, 2006). Narrative analyses utilize the analytic approaches of narrative research for the study of psychotherapy process, whereas the study of narrative in therapy focuses on the stories told in therapy, which may or may not involve a narrative analysis.

² The formula for this model is: proportion = B0 + B1.1*X1.1 + B1.2*X1.2 + B2*X2 + B31*X3.1 + B32*X3.2+ B4.1*X1.1*X2 + B4.2*X1.2*X2 + B5.1*X1.1*X3.1 + B5.2*X1.2*X3.1+ B5.3*X1.1*X3.2 + B5.4*X12*X3.2 + B6.1*X2*X3.1 + B6.2*X2*X3.2 + B7.1*X11*X2*X3.1 + B7.2*X1.2*X2*X3.1 + B7.3*X1.1*X2*X3.2 + B7.4*X1.2*X2*X3.2 + e_dyad + e_residual.Where the X_i vectors are dummy-coded: X_1.1: Stage = Middle, X_1.2: Stage = Late, X₂: Outcome = Poor, X_3.1: Treatment = CT, X_3.2: Treatment = EFT.